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Income Taxes (Tables) | 12 Months Ended
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Dec. 31, 2019
Income Tax Disclosure [Abstract] |
Schedule of Provision for Income Taxes | Provision for income taxes consisted of the following:
| Years ended December 31,
| 2019 |  | 2018 |  | 2017
Current |  |  |  |  |
Federal | $ | 9,034,736 |  |  | $ | 21,058,703 |  |  | $ | 19,219,251 |
State | 5,924,933 |  |  | 9,646,172 |  |  | 5,336,885 |
| 14,959,669 |  |  | 30,704,875 |  |  | 24,556,136 |
Deferred |  |  |  |  |
Federal | (3,508,348 | ) |  | (5,954,666 | ) |  | (18,718,113 | )
State | (3,284,689 | ) |  | (2,390,569 | ) |  | (1,951,238 | )
| (6,793,037 | ) |  | (8,345,235 | ) |  | (20,669,351 | )
Total provision for income taxes | $ | 8,166,632 |  |  | $ | 22,359,640 |  |  | $ | 3,886,785 |
Schedule of Components of Deferred Tax Assets (Liabilities) | Significant components of the Company's deferred tax assets (liabilities) as of December 31, 2019 and December 31, 2018 are shown below. During the year ended December 31, 2019, the Company recorded a non-cash reclassification $0.9 million of deferred tax liabilities to income tax payable related to utilization of NOLs. A valuation allowance of $8.2 million and $3.4 million as of December 31, 2019 and December 31, 2018, respectively, has been established against the Company's deferred tax assets related to loss entities the Company cannot consolidate under the Federal consolidation rules, as realization of these assets is uncertain.
| 2019 |  | 2018
Deferred tax assets (liabilities) |  |  |
State taxes | $ | 1,110,659 |  |  | $ | 1,886,010 |
Stock options | 1,293,164 |  |  | 1,660,664 |
Accrued payroll and related cost | 277,682 |  |  | 238,633 |
Accrued hospital pool deficit | 188,075 |  |  | 168,413 |
Allowance for bad debts | 544,028 |  |  | 1,124,917 |
Investment in other entities | 2,977,431 |  |  | 884,922 |
Net operating loss carryforward | 13,849,685 |  |  | 6,414,256 |
Lease liability | 3,567,302 |  |  | — |
Property and equipment | (927,011 | ) |  | (1,286,087 | )
Acquired intangible assets | (29,195,045 | ) |  | (24,084,892 | )
Right-of-use assets | (3,544,315 | ) |  | — |
Risk Pool Receivable | (1,623,049 | ) |  | (2,434,573 | )
Other | 1,403,446 |  |  | (792,781 | )
Net deferred tax liabilities before valuation allowance | (10,077,948 | ) |  | (16,220,518 | )
Valuation allowance | (8,191,500 | ) |  | (3,395,417 | )
Net deferred tax liabilities | $ | (18,269,448 | ) |  | $ | (19,615,935 | )
| 2019 |  | 2018
Tax valuation allowance |  |  |
Beginning balance | $ | 3,395,417 |  |  | $ | 3,224,517 |
Charged (credited) to tax expense | 1,085,842 |  |  | 170,900 |
Charged to goodwill | 3,710,241 |  |  | — |
Ending balance | 8,191,500 |  |  | 3,395,417 |
Schedule of Effective Income Tax Rate Reconciliation for Provision for Income Taxes | The provision for income taxes differs from the amount computed by applying the federal income tax rate as follows for the years ended December 31:
| Years ended December 31,
| 2019 |  | 2018 |  | 2017
Tax provision at U.S. Federal statutory rates | 21.0 | % |  | 21.0 | % |  | 35.0 | %
State income taxes net of federal benefit | 8.1 |  |  | 6.7 |  |  | 4.4 |
Non-deductible permanent items | 3.3 |  |  | 1.3 |  |  | (9.7 | )
Non-taxable entities | (2.7 | ) |  | (0.7 | ) |  | (1.9 | )
Stock-based compensation | (1.5 | ) |  | (1.8 | ) |  | 0.9 |
Change in valuation allowance | 13.7 |  |  | — |  |  | (2.9 | )
Entity Conversion | (10.5 | ) |  | 0.5 |  |  | — |
Change in rate | — |  |  | — |  |  | (19.4 | )
Other | 0.2 |  |  | 0.1 |  |  | 1.4 |
Effective income tax rate | 31.6 | % |  | 27.1 | % |  | 7.8 | %

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- Definition Tabular disclosure of the components of income tax expense attributable to continuing operations for each year presented including, but not limited to: current tax expense (benefit), deferred tax expense (benefit), investment tax credits, government grants, the benefits of operating loss carryforwards, tax expense that results from allocating certain tax benefits either directly to contributed capital or to reduce goodwill or other noncurrent intangible assets of an acquired entity, adjustments of a deferred tax liability or asset for enacted changes in tax laws or rates or a change in the tax status of the entity, and adjustments of the beginning-of-the-year balances of a valuation allowance because of a change in circumstances that causes a change in judgment about the realizability of the related deferred tax asset in future years. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 740 -SubTopic 10 -Section 50 -Paragraph 9 -URI http://asc.fasb.org/extlink&oid=84230637&loc=d3e32639-109319 + Details
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- Definition Tabular disclosure of the components of net deferred tax asset or liability recognized in an entity's statement of financial position, including the following: the total of all deferred tax liabilities, the total of all deferred tax assets, the total valuation allowance recognized for deferred tax assets. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 740 -SubTopic 10 -Section 50 -Paragraph 2 -URI http://asc.fasb.org/extlink&oid=84230637&loc=d3e32537-109319 + Details
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